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Telehealth Coverage for Annual Wellness Visits

Effective March 6, 2020, CMS expanded telehealth services to include annual wellness visits (AWVs) for Blue Advantage® patients through 2024.

Claims Information
Providers should perform AWVs using both audio and video technology
and file appropriate codes related to these services. Telehealth AWV claims must include HCPCS code G0438 or G0439, with place of service code 10 (patients who are in their homes) or place of service code 02 (patients outside of their homes).

Body mass index and blood pressure results for the patient will not be required for telehealth AWV claims.

We do understand that some patients may not have access to video technology. In such cases, the patient's medical record encounter documentation should note that services were rendered via audio telecommunications only due to the patient not having access to video capabilities.

We recommend that providers review the Patient Health Snapshot for a reference of chronic conditions to evaluate, document and code on the AWV claim. Additionally, if a patient is due for a colon cancer screening, a Cologuard® test could be performed at home.

Guidance for AWVs Performed via Telehealth
We are following CMS guidance regarding telehealth services for AWVs:

  • The provider should already have an established relationship with the patient in order to do a wellness visit via telehealth.
  • The patient must virtually consent to using telehealth for a wellness visit and the consent must be documented within the medical record prior to the patient using the service.